POS1549-HPR IMPROVING EFFICACY AND SAFETY OF BLOOD MONITORING IN RHEUMATOLOGY PATIENTS ON DISEASE MODIFYING ANTI-RHEUMATIC DRUGS (DMARDs) USING A NEW AUTOMATED ALGORITHM
Authors: M. Mirza, A. Escudero Siosi, D. Lang, K. Paddon, B. Shine, A. Soni, R. Luqmani
Journal: Annals of the Rheumatic Diseases (2022)

Background Most patients in Rheumatology require early management with DMARDs to control their disease. In our department, around two hundred patients start a DMARD therapy every month and monitoring their blood test results whilst on DMARDs play an essential role to detect toxicity and the need for further action. This process has been done manually, which has been prone to error. Over the past six months, a minimum of three patients have had abnormalities which were missed, consequently identifying the need to improve the quality of the blood monitoring. Objectives The aim of the project was to develop, test and implement an automated algorithm to review multiple blood test results and highlight any changes, trends or abnormalities in patients starting DMARD therapy efficiently. Methods We designed a system to automatically review blood tests from patients newly started on DMARD therapy, following the recommended British Society for Rheumatology (BSR) schedule for blood monitoring. Results are processed in our local laboratory, subsequently uploaded to our unique database and analysed automatically using an algorithm against BSR guided threshold values for each blood test. According to the value, each blood result is identified as normal, mildly abnormal, missing, trending, or abnormal. A trained clinician or pharmacist will review the data and endorse the results after taking any appropriate action. Based on the results, if any actions are needed, patients are contacted either by phone or via a letter automatically generated by this software, recommending them to have a repeat test or temporarily stop the medication as required. Results The system was tested on two cohorts, comprised of 100 and 227 blood tests. It was faster and more efficient than the manual alternative. Following this test, each record was compared manually, based on the data stored on a spreadsheet. This new system led to the identification of more abnormalities versus the manual inspection (29% vs 10%, Chi square P&lt;0.001). Additionally, it took less than a minute compared to the manual method, which took three hours to complete. Follow up manual inspection confirmed that the new system had correctly identified every abnormality, based on test records. To date, we have analysed 3568 blood results using this technique. 1564 (44%) results have been normal and endorsed within seconds. 374 (10%) were mildly abnormal, 17 (0.5%) results have been abnormal requiring action and 311 (9%) were abnormal requiring no action. 265 (7%) results showed a trend within the blood results. Trending results were defined as being out of range and worsening on two consecutive occasions but not reaching the limits for stoppig a drug. 1032 (29%) results contained missing results, a consequence of the different timings of results uploaded by various laboratory sections. Conclusion We have developed an efficient and safe blood monitoring system for Rheumatology patients starting on a DMARD, proven to be more accurate compared to previous manual alternatives and able to process up to 10,000 results at a time. Disclosure of Interests None declared